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Neue Therapieansätze bei Hämangiomen: Angiotensin-Converting-Enzym-Hemmer

Eine interessante neue Arbeit ist vor einigen Wochen in England erschienen. Kindliche Hämangiome mit ACE-Hemmern zu behandeln, ist ein vollständig neuer und innovativer Therapieansatz. Hier der Abstract (Tan ST et al., British Journal of Dermatology. 2012 Apr 25):


Recently infantile haemangioma (IH) has been reported as an aberrant proliferation and differentiation of a primitive mesoderm-derived haemogenic endothelium regulated by the renin-angiotensin system (RAS), leading us to propose angiotensin converting enzyme (ACE) as a potential therapeutic target.

After initial screening investigations, infants with problematic IH were admitted for initiation of captopril with a 0.1mg/kg test dose orally, followed by dose escalation to 0.3mg/kg/dose 8-hourly over 24 hours.

The dose increased up to 0.5mg/kg/dose 8-hourly one week later, if a noticeable involution had not already occurred. The response of IH to captopril was documented clinically and photographically before and after treatment and any side effect was recorded.

Two males and six females aged 5-22 (mean 12.9) weeks with problematic IH were recruited with the lesions located in nasal tip (n=1), cervico-facial (n=3), peri-orbital (n=1) and perineal (n=2) areas, and shoulder (n=1). Transient mild renal impairment occurred in one subject which resolved spontaneously.

No other complication was observed. The IH(s) in all patients responded to captopril at a dose of 1.5mg/kg/day which led to a dramatic response in three, moderate response in two, and slow response in three patients.

Continued involution of IHs was observed during the follow-up period of 8-19 (mean 15.8) months in all subjects. Treatment was ceased at 14 months of age in seven patients with no rebound growth. In the remaining patient, rapid healing occurred with on-going gradual reduction in the size and colour of a large ulcerated retroauricular lesion following 5.5 months of treatment.

The lesion was excised to address its persistent distortion of the ear. The response of IH to an ACE inhibitor supports a critical role for RAS in IH and represents a paradigm shift in the understanding and treatment of this enigmatic condition.

 

Leiter des Ped Mind Institutes
Stefan Bittmann, M.D., M.A.
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